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. 2025 Dec 27.
doi: 10.1111/imj.70311. Online ahead of print.

Validation of the American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator in predicting geriatric outcomes in patients with neck of femur fractures

Tessa Lo  1 , Shiu Lai  1 , Tanita Botha  2   3 , Stephanie Than  1   4
Affiliations

Validation of the American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator in predicting geriatric outcomes in patients with neck of femur fractures

Tessa Lo et al. Intern Med J. .

Abstract

Background: Hip fractures are associated with poor functional outcomes and increased mortality. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) surgical risk calculator is an open access tool that estimates the probability of postoperative outcomes.

Aims: To externally validate the calculator in predicting geriatric outcomes (delirium, functional decline, pressure injury), 30-day inpatient mortality and discharge destination in patients aged 65 and older undergoing surgical fixation of neck of femur fractures.

Methods: A retrospective single-centre cohort study of patients admitted from July 2022 to June 2023 to a large, metropolitan health service in Melbourne, Australia, was conducted. The calculator's performance was analysed using the area under the receiver operating characteristic curve (AUC), the Hosmer-Lemeshow test and the Brier score.

Results: We included 305 patients in the study. Mean age was 82.4 ± 7.8 years and 215 (70.5%) were female. The calculator performed well for predicting delirium (AUC 0.859, 95% CI 0.811-0.902, Brier score 0.150), functional decline (AUC 0.883, 95% CI 0.826-0.935, Brier score 0.120) and mortality (AUC 0.854, 95% CI 0.774-0.917, Brier score 0.065). Results from the Hosmer-Lemeshow test for all of these outcomes demonstrated good calibration. The calculator had reduced performance in predicting discharge destination and pressure-injury risk.

Conclusion: The calculator is a moderately reliable predictor of delirium, functional decline and inpatient mortality in older patients who undergo hip fracture surgery. Further prospective research is required to validate it across other Australian healthcare settings.

Keywords: aged; femoral neck fractures; hip fractures; postoperative outcomes; risk.

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References

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    1. Australian and New Zealand Hip Fracture Registry. Annual Report of Hip Fracture Care 2024. Sydney: ANZHFR; 2024. https://anzhfr.org/wp-content/uploads/sites/1164/2024/09/ANZHFR-2024-Ann....
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    1. Wiles MD, Moran CG, Sahota O, Moppett IK. Nottingham hip fracture score as a predictor of one year mortality in patients undergoing surgical repair of fractured neck of femur. Br J Anaesth 2011; 106: 501–504.

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